Paediatric Audiology Services

Our Paediatric or Children’s Audiology Service offers hearing assessments for children from birth until the age of 18 when we will then assist young adults to transition to Adult Audiology Services.

Our paediatric audiologist have training and experience in assessing and identifying hearing difficulties. When hearing loss is identified, our paediatric audiologist will work closely with other professionals (ENT, SLT, Educational audiology and charitable organisations), and with the child and the family to reduce the impact which hearing difficulties may cause.

Referrals into Paediatric Audiology

• Newborn Hearing Screening Programme (NHSP).
• Health Visitor, Speech and Language Therapists and Paediatrics can refer up to school age.
• School nurse
• Children referred by their GP into ENT (Ear, Nose and Throat).

Children may be referred to Paediatric Audiology for the following reasons:

• Child appears to be mishearing or not hearing when spoken too
• TV volume set too loud
• Struggling to communicate
• Speaking loudly
• Changing behaviour and becoming frustrated
• Difficulties hearing at school
• A follow up appointment may have been made following the Newborn Hearing Screening Programme (NHSP).
• Delayed speech, language and communication
• Request from another professional, such as a Paediatrician
• A routine check-up due to having a linked medical condition e.g. a syndrome with risk of developing hearing problems
• For assessment following certain illnesses e.g. bacterial meningitis

Audiology assessment

At the initial paediatric audiology assessment, there may be 1 or 2 audiologists and the time of assessment will be around 40 minutes to 1 hour. A return visit may be necessary if all parts of the assessment are not complete in one visit.

What we will do

We may ask you some questions regarding your child’s:

• Response to sounds
• Overall health
• Relevant medical history
• Family history of hearing problems
• Parental concerns
• Speech development
• Understanding

Testing will be carried out by encouraging your child to respond to sounds whilst playing.  These tests will take place a quiet room therefore we would ask where possible that you only bring the child who is being tested.

We may also look in your child’s ear and if necessary we will carry out some objective tests which are not invasive. Most children enjoy their assessment as the emphasis is very much on play.

When the assessment is complete we will discuss the results and create an individual management plan. If your child’s hearing levels are within the normal range we may agree that no further action is required and discharge your child from the Paediatric Audiology Service. If hearing loss is identified we may arrange further follow up, additional assessments or hearing monitoring.

Objective testing

Objective testing can measure how the different parts of the hearing system react to sound without the child having to actively respond. The Audiologist will choose the most appropriate method of testing for your child.

Objective testing includes;

• Otoacoustic Emissions
• Tympanometry
• Middle Ear Reflex
• Auditory Brainstem Responses

Otoacoustic Emissions

This test is used on New-born babies but is also used as part of some audiology assessments.

This is recorded by measuring the inner ear response to a small sound stimulus using a small soft probe tip in the outer portion of the ear canal. This does not require the child to respond but this must be done in a quiet area and the child should be well settled.

Tympanometry

This requires a soft tip to be inserted in the outer portion of the ear canal. Once the tip is inserted a small amount of gentle pressure is administered this will give information on how the eardrum is moving. Tympanometry is quick and painless.

Auditory Brainstem Response

The Auditory Brainstem Response (ABR) is a test to establish hearing levels. Recordings are taken of activity from your child’s hearing pathway in response to sound while your child sleeps. It involves placing four sticky back electrodes (like sticking plasters) on or around the scalp, two on the forehead and one behind each ear. A set of headphones are placed over the ears to deliver a sound which induces a response from the hearing pathway.

We suggest keeping your child awake until the Audiologist places the electrodes on your child’s head and then some time is set aside to enable you to settle your child. Once baby is sleeping the ABR test recording can begin, this part usually takes 30 to 50 minutes. Enough time is set aside to allow your child to settle and have the assessment completed, though it is important to arrive on time. It is usual to expect a stay of 90 minutes or more unless your child settles very quickly.

Due to the length of the time the test may take and in accordance with NHS recommendations the test cannot be carried out on young babies while in a car seat. We suggest bring a buggy or pram to the appointment.

Behavioural testing

Our team may also carry out behavioural testing. The testing used will depend on the child’s developmental age.  Most behavioural testing involves delivering sounds and assessing the child’s responses to these sounds.

Behavioural tests require the child to be awake and may involve the child playing with some toys or cooperating in listening games.

Behavioural testing may include;

• Visual Reinforcement Audiometry (VRA)
• Performance / Play audiometry

Visual Reinforcement Audiometry (VRA)

Visual Reinforcement Audiometry involves sounds being emitted from a speaker or headphone.

The child will initially be conditioned to look for a picture or toy when a sound is being emitted, once the child has been conditioned to perform the game appropriately the levels will be changed to allow the audiologist to determine the smallest sounds the child can detect.

Performance/Play audiometry

This test is performed like a game and requires the child play with toys. The child will be asked to perform a task when they hear a sound. They may be asked to “feed the piggy bank” for each sound. The audiologist will initially condition the child to the game and ensure the child will wait to hear the sound before performing the task.

Once the child can perform the task correctly, the levels will be changed to determine the smallest sound the child can detect at a range of pitches.

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All the test results will be collected on the day of the assessment. The result will then be discussed with the parent/carer. The audiologist will then work with the parent/carer to create an individual management plan.

The result from this assessment will formulate the individual management plan which will be provided to parents / guardians for sharing with relevant professionals.

What happens if my child has a hearing loss?

If a hearing loss is identified the treatment will depend on the nature/cause of the hearing loss. Sometimes monitoring of the hearing may be required.

Hearing aids may be indicated if the hearing loss is permanent or persistent. Children with hearing loss will also be referred to an Ear Nose and Throat (ENT) specialist for a medical advice. An individual management plan will be agreed to identify appropriate support.

What if my child needs a hearing aid?

If your child has a persistent or permanent hearing loss we will offer appropriate support. We will discuss the use of amplification from a hearing aid and we will also refer to the Ear Nose and Throat department for further medical advice.

Behind the ear (BTE) hearing aid

These hearing aids are particularly well suited to children as they are durable and can easily be connected to assistive listening devices such as FM systems for school. Amplification is delivered to the ear canal from a behind the ear hearing aid through a small tube attached to an ear mould. As children grow these hearing aids can be adjusted to allow for changes due to growth. The model of BTE supplied will depend on the hearing needs of the child.

To ensure the sound gets into the ear canal, your child will require an impression to be taken of their ear to make an ear mould. A small foam stopper will be inserted into the ear canal and then a soft silicone material gently positioned into the ear, this sets in 1-2 minutes.

Ear moulds can be personalised with various colours available. We encourage hearing aids to be customised for the child as this creates a sense of ownership which makes them more likely to wear it. We can provide a range of colours and stickers and designs for hearing aids and ear moulds.

We do not fit In the ear (ITE) hearing aids for children as they are less durable and adaptable than BTE aids, particularly in the rapidly growing child.

Bone conductor aids

Bone Conductor hearing aids may be used for those who are not suitable for conventional hearing aids. These are attached to the bone behind the ear using a soft band. Bone Conductor Hearing aids can be surgically implanted in older children and adults.

Further information regarding support from professionals who may be involved: https://www.northerntrust.hscni.net/services/audiology/childhood-hearing-loss-services-working-group/

Glue ear

Glue ear is one of the most common childhood conditions which occurs when the middle ear fills with sticky fluid. This is usually temporary and linked to upper respiratory tract infections, but long-term glue ear with reduced hearing can ultimately affect speech development.

There are various treatment options, which include watching and waiting, hearing aids or grommets which are surgically placed.